浅谈肿瘤患者深静脉置管方法和护理

目的:探讨深静脉置管在长期化疗和肠外营养的肿瘤患者的使用价值。方法:对176例深静脉穿刺置管病人的置管方法、护理措施、留置时间及并发症进行回顾性分析。结果:留置时间10～362d,平均99.6d,172例患者带管出院,无l例导管滑脱,保证化疗的顺利实施及病人肠外营养的长期使用。结论:深静脉置管只要护理得当,均可以带管出院,为肿瘤病人重复化疗和长期肠外营养提供较好的治疗通道。     

PICC导管临床应用及体会

PICC导管(外周中心静脉置管)在肿瘤患者使用,此种穿刺方法简单、易操作、保留时间长、留置管通畅无回血及血栓形成,既能保证病人按时化疗,又可减少化疗导致的静脉炎及渗漏性损伤的发生,是减轻病人痛苦提高护理质量的好方法。     

免疫增强型肠内营养制剂在胃癌术后病人辅助化疗中的作用

目的:观察应用免疫增强型肠内营养制剂对胃癌术后病人辅助化疗中的临床疗效。方法:将84例胃癌术后辅助化疗病人随机分为A、B两组,每组42例。两组病人均于术中放置空肠穿刺造口管,并延期留置空肠造口管直至化疗6个疗程结束。A组每个化疗疗程经空肠造口管给予免疫增强型肠内营养液瑞能,每天1 500ml,共7 d;B组则每个化疗疗程经空肠穿刺造口管给予普通匀浆膳食,每天1 500 ml,共7 d。比较两组病人化疗后营养和免疫指标。结果:化疗后A组血红蛋白、血清清蛋白、前清蛋白及IL-2、NK细胞活性、CD3+、CD4+、CD4+/CD8+水平显著高于B组(P0.05)。结论:在胃癌病人术后辅助化疗期间,应用免疫增强型肠内营养制剂能减少化疗药物对病人营养状况和免疫功能的影响。     

浅谈深静脉置管封管时间

深静脉置管正广泛应用于临床，为抢救危重病人，减少患者因长期输液血管条件差，反复穿刺的痛苦，我科对肿瘤病人长期化疗血管破坏严重的患者，采用美国AROW公司生产的单腔静脉导管进行深静脉置管，用肝素稀释液封管，定期给予化疗药物，避免了穿刺失败及静脉炎的发生。     

中心静脉与外周静脉置管在肿瘤化疗中的应用

目的:观察中心静脉置管与外周静脉置管在恶性肿瘤患者化疗中的应用.方法:采用随机对照的研究方法,对71例恶性肿瘤患者随机分为两组进行观察.结果:一次性置管成功率两者无显著差别;中心静脉置管留管时间远长于外周静脉置管留管时间;中心静脉置管组未发生化疗所致栓塞性静脉炎及药物外渗,而外周静脉置管组则有64.7%的病例发生化疗所致栓塞性静脉炎及药物外渗.结论:中心静脉置管安全,可长期保留,在恶性肿瘤病人的化疗、抢救和高营养治疗中有较高的临床价值,提高了病人的生存质量,值得广泛推广使用.     

锁骨下静脉置管化疗的应用及护理

为有效控制肿瘤的发展,反复多次大剂量静脉冲击化疗,已成为临床抗肿瘤的常规治疗方法.但化疗药物刺激性较强,易引起药物外渗或外漏,造成静脉、局部组织损伤甚至坏死,不仅给病人带来痛苦,而且影响化疗的顺利进行.为减少病人痛苦,我院对化疗病人分别采用锁骨下静脉置管与外周静脉留置针化疗两种方法.现对2004年1月～2007年9月间120例恶性肿瘤化疗病人进行比较,观察锁骨下静脉置管局部毒性反应的发生情况.     

肿瘤病人行锁骨下静脉置管术的护理

肿瘤患者当外周静脉条件较差或注射强刺激化疗药物时，常选择锁骨下静脉置管化疗。患者由于疾病本身的影响及血液粘稠度较高，机体抵抗力低下，导致堵管率和感染率往往高于一般患者。为降低其导管堵管率及感染率，延长导管留置时间，让患者顺利完成化疗，2003年10月起，我科对98例行锁骨下静脉置管的病人采用了新的护理方法，取得了较好的临床护理效果。现将体会报告如下：     

便携式化疗泵配合中心静脉置管在临床持续化疗中的应用及护理

目的总结便携式化疗泵配合中心静脉置管持续化疗的护理经验。方法对169例癌症患者采用化疗泵配合中心静脉置管持续化疗。结果全部病例圴顺利完成全程化疗,未出现任何不良反应及并发症。结论便携式化疗泵配合深静脉置管持续化疗不仅使药物在体内保持一定的血药浓度,为肿瘤病人提供了一条安全、方便的无痛性治疗途径,而且减轻医护人员的工作强度并得到患者的欢迎。精心的护理是顺利使用的关键。     

外周中心静脉置管在乳腺癌病人化疗中的应用

目的 保护血管,避免化疗药物外渗,防止静脉炎发生,减少患者痛苦.方法 将我院2006年10月～2008年2月共72例乳腺肿瘤患者健侧肢体实施经外周穿刺中心静脉置管(PICC),并观察置管的一次成功率,静脉炎、药物外渗主要并发症发生情况及留置时间.结果 置管成功率为94.7%;留置时间38～159天(平均122天);静脉炎发生率6%;药物外渗率0%;其它并发症发生率4.8%.结论 PICC穿刺方法 简单、易操作、保留时间长、既能保证病人按时化疗,又可减少化疗导致的静脉炎及渗漏性损伤的发生,是减轻病人痛苦提高护理质量的好方法 .     

采用深静脉置管对肿瘤患者进行化疗的护理体会

目的总结分析对300例肿瘤患者进行深静脉置管化疗的护理效果。方法随机选择300例晚期肿瘤患者进行化疗，采用深静脉置管的方法，观察患者输液反应情况。结果穿刺成功率100％，置管时间5～15d，置管后活动自如，输液时无局部反应，无局部皮肤红、肿、痛，拔管后伤口愈合好，无1例感染；无导管脱落。拔出深静脉置管操作简单，使用安全，效果良好，置管时应严格无菌操作和保持正压封管以及精心护理是安全长期置管的重要保证。结论采用深静脉置管的方法进行化疗，可减轻化疗时的局部输液反应，对于长时间化疗的患者不失为一种好方法。     

化疗期卵巢癌患者焦虑与生活质量的关系

目的：调查卵巢癌患者化疗期的情绪和生活质量的特点及两者之间的关系。方法：采用汉密尔顿焦虑量表（HAMA）和卵巢癌生命质量测定量表（FACT-B4．0）对60例卵巢癌患者进行问卷调查。结果：患者化疗初期焦虑水平高于化疗中、末期，比较差异有统计学意义（P〈0．001）；卵巢癌患者生活质量的功能状况均数逐渐增加，其他因子和总分均数在化疗中期最低，化疗末期最高。焦虑与附加关注负相关（r=-0．221，P=0．028）。结论：患者的焦虑情绪随着化疗而改善，在化疗不同阶段，卵巢癌患者的生活质量有差异，化疗中期最差，化疗末最高。焦虑情绪对患者总体生活质量无明显影响，但会影响生活质量的某些方面。     

Lamivudine for the prevention of chronic hepatitis B exacerbations during chemotherapy for non-Hodgkin's lymphoma

Two male patients, aged 54 years and 17 years respectively, were treated with chemotherapy for non-Hodgkin lymphoma. Both patients were chronic hepatitis-B-virus (HBV) carriers prior to the chemotherapy. One patients died as a result of the virus exacerbating during chemotherapy; the other patient received the antiviral drug lamivudine prior to the chemotherapy and finished the cures without any problems. Exacerbations of HBV replication followed by an increase in serum transaminase activity levels ('flares') occur naturally during the course of the viral infection. However, there is an elevated risk when a patient receives high doses of corticosteroids for a short period, as is the case in chemotherapy for non-Hodgkin's lymphoma. Lamivudine is registered for the treatment of chronic hepatitis B and can be used as a prophylactic prior to chemotherapy or to treat an exacerbation of the hepatitis. It is advisable to systematically test all patients with lymphoma for the presence of the HBsAg. If this is positive, prophylactic administration of lamivudine 100 mg once daily is strongly recommended if chemotherapy is indicated.     

化疗对乳腺癌患者骨密度的影响

目的探讨化疗（药物治疗）对乳腺癌患者骨密度的影响及可能的机制。方法68例乳腺癌患者（绝经前28例,绝经后40例）和50例正常对照。乳腺癌患者术后均常规化疗。其中绝经前患者化疗结束后按月经状况分为：A组16例,化疗结束后继续行经;B组12例,化疗结束后停经。所有研究对象均测量基线骨密度（BMD）;用双能X线吸收测定仪（DEXA）测量腰椎和左髋部位的BMD,分别比较肿瘤组化疗前、后,A组与B组化疗结束后BMD的变化。结果肿瘤组化疗后腰椎和左髋部位的BMD比化疗前均显著降低（P〈0．05）;B组化疗结束后较A组化疗结束后腰椎和左髋部位的BMD均有明显降低（P〈0．05）。结论化疗导致乳腺癌患者骨量早期丢失。对于绝经前的患者,卵巢功能衰竭是引妒骨量丢失最重要的原因。     

Chemotherapy for metastased non-small cell lung cancer

Only a select group of patients with metastased non-small cell lung cancer are eligible for treatment with chemotherapy. The standard treatment for patients with a good performance score, and possibly also for those with physical limitations as a consequence of the disease, is chemotherapy consisting of cisplatin or carboplatin in combination with a third-generation cytotoxic agent together with maximum supportive care. The optimal duration of this chemotherapy treatment is at least 3 to 4 cures, less in the case of disease progression. For older patients (> 70 years) with a good performance score, chemotherapy with maximum supportive care is the standard treatment. However, which form of chemotherapy should be given is not yet clear. Symptomatic improvement is important for improving the quality of life. For patients with tumour relapse or disease progression after first-line chemotherapy who still have a good performance score, the standard treatment is once again chemotherapy with maximum supportive care, as this improves the chance of survival and quality of life, and is possibly cost effective.     

宫颈癌新辅助化疗临床研究

目的:观察新辅助化疗治疗宫颈癌的疗效并探讨其临床意义。方法:对34例宫颈癌患者进行新辅助化疗,然后再进行手术治疗。结果:34例患者经过两个疗程的化疗后,完全缓解4例,部分缓解12例,稳定10例,进展8例,总治愈率76.47%。对患者进行术后的病理检查,发生淋巴结转移4例。结论:运用新辅助化疗对宫颈癌进行治疗是安全有效的,其作为一种新的治疗宫颈癌的手段,临床意义显著。     

不同肠内营养支持对恶性肿瘤患者术后化疗效果的评价

目的：研究恶性肿瘤患者术后化疗期间应用肠内营养支持对营养状况、免疫功能的影响。方法：将80例需进行化疗的恶性肿瘤术后患者随机分为研究组（EN）和对照组,研究组40例,在常规饮食的基础上,采用肠内营养支持;对照组40例,进食常规饮食,不进行肠内营养支持。分别观察两组患者化疗前、化疗第28天和化疗第56天时血清白蛋白（Alb）、前白蛋白（PA）、血红蛋白（Hb）和淋巴细胞亚群（包括NK、CD4、CD8、CD4/CD8）、免疫球蛋白（包括IgG、IgM、IgA）的变化情况。结果：化疗第28天时两组差别不明显（P〉0.05）;化疗第56天时,研究组血清白蛋白、前白蛋白、血红蛋白高于对照组（P〈0.05）,与化疗前差异不大（P〉0.05）,对照组血清白蛋白、前白蛋白、血红蛋白明显低于化疗前,有统计学差异（P〈0.05）,两组免疫指标均低于化疗前,其中研究组免疫指标下降低于对照组,差异有统计学意义（P〈0.05）。结论：恶性肿瘤患者术后化疗期间应用肠内营养支持有利于机体营养状况和免疫功能的维持和改善。     

便携式化疗泵治疗宫颈癌的安全管理研究进展

便携式化疗泵由于结构的特殊性,可以较好的用于治疗Ⅱb期以上宫颈癌放疗辅助化疗增敏的患者。其既可提高治疗效果,减轻化疗的毒副反应;又可减少对患者反复穿刺带来的痛苦,避免化疗药物对血管的损害和渗漏,同时可提高工作效率,减轻工作量。便携式化疗泵在使用过程中因各种原因会存在不安全因素,因此,需要对存在的问题不断地进行分析,并加强对使用的安全管理。     

The quality of life of cancer patients who refuse chemotherapy

The study compared the quality of life of 51 cancer patients who dropped out of chemotherapy, 19 who refused treatment and a further 70 patients who had completed chemotherapy. The patients were treated in five oncological institutes in Israel. The findings of this study indicate that the quality of life of patients who refuse chemotherapy is no different from that of patients who drop out of treatment or patients who complete treatment. The findings also show that the quality of life of the patients who drop out of treatment is worse than that of patients who complete chemotherapy.     

BCL-2和Bax表达在宫颈癌新辅助动脉化疗疗效评价中的作用探讨

目的:探讨BCL-2和Bax基因表达在宫颈癌新动脉化疗评价中的作用。方法:随机选择60例宫颈癌患者进行研究(动脉化疗组32例,静脉化疗组28例)。采用免疫组化法检测化疗前和化疗后15天宫颈癌组织的凋亡相关基因BCL-2和Bax,并根据病理损伤程度进行疗效评价。结果:动脉化疗组的病理缓解率为81%,与静脉化疗组的53%比较,差异有显著性;通过对动脉化疗前、后肿瘤细胞凋亡相关基因BCL-2、Bax的检测,发现Bax高表达者其病理缓解疗效明显优于Bax低表达者,且动脉化疗后Bax基因表达增加,而静脉化疗前后凋亡相关基因表达的比较却无差异。结论:动脉化疗的疗效优于静脉化疗,Bax基因表达的检测可作为预测患者动脉化疗敏感性的指标之一。     

Adjuvant chemotherapy in patients operated on for early ovarian carcinoma

The desirability of adjuvant chemotherapy in patients with early ovarian carcinoma, i.e. a carcinoma limited to the internal genitalia (FIGO stage I-IIA), has long been controversial. Until recently, the few randomised studies that had been performed showed no improvement in survival after adjuvant chemotherapy, but the numbers of patients were too low to yield convincing proof. Complete surgical staging in patients with early ovarian carcinoma is of utmost importance to define the stage of the disease. In case of inadequate staging, there is a 24% risk (range 16-46%) that undetected tumour deposits will remain in the abdominal cavity following surgery, so that the estimated stage will be too low. The combined results of the two largest randomised clinical trials on early ovarian carcinoma to date have recently been published: the 'Adjuvant chemotherapy in ovarian neoplasm' (ACTION) trial, coordinated by the European Organisation for Research and Treatment of Cancer (EORTC), and the 'International collaboration in ovarian neoplasm' (ICON-1) trial; they showed a significant benefit from adjuvant chemotherapy on overall and progression-free survival in early ovarian cancer. The ACTION trial (448 patients), however, also showed that adjuvant chemotherapy only improved the overall and disease-free survival significantly in inadequately staged patients. In the patients who had undergone optimal surgical staging, adjuvant chemotherapy had no effect on the prognosis. In the ICON-1 study (477 patients) there was a favourable effect of adjuvant chemotherapy in the whole population. Analysis of this trial, however, shows that most probably only a very small percentage of these patients had undergone optimal surgical staging. Based on the published results, the best policy for the treatment of patients with early ovarian cancer is felt to be to make every effort to achieve optimal surgical staging and to reserve the burdensome adjuvant chemotherapy for those patients in whom optimal (re)staging is not feasible.